The author emphasizes the systemic approach in treating both asymptomatic (no discernible symptoms) and symptomatic athletes, and this is well supported by his own clinical experience and equally by findings of evidence-based research in sports medicine. The purpose of the systemic approach is to adjust the biomechani-cal alignment and balance of the core structure, especially to release stress in the soft tissue of the spine to facilitate stability and strengthening of the core.
Since the late 1990s, core strengthening and stability has become the focus in sports rehabilitation and performance training. However, the concept of core strength was suggested as early as the 1920s by Joseph Pilates,2 who noticed that developing a girdle of strength required recruitment of the deep trunk muscles. In addition, rehabilitation experts in various disciplines have historically taught the concept that stability of proximal segments is required for effective mobility of distal segments. For instance, a stable pelvis and trunk are needed for controlled movement at the knee and ankle.
Hodges and Richardson2 revived the concept of core stability in the 1990s. They described the spine as inherently unstable and requiring active support from intra-abdominal pressure and tension-ing of the thoracolumbar fascia and deep lumbar stabilizers. Core strength is thus considered to be the muscular support of the lumbar spine, which is necessary to achieve and maintain functional stability.3 More recently, this concept has been expanded to include muscles of the hip4 and the scapulothoracic musculature.5 Properly developed core strength, providing sufficient core stability, has been suggested as a necessity for maintaining correct posture and alignment of lumbar and pelvic regions during all movement and particularly in sport because it enables powerful and coordinated extremity movements. Inadequate core strength results in poor core stability and may decrease bio-mechanical efficiency, as well as increasing the risk of injury.
Several studies have confirmed the relationship between core muscle weakness and the likelihood of injury. Some examples are mentioned here:
• Activation of the transversus abdominis muscle is significantly delayed among individuals with low back pain.2
• Trunk extensor isokinetic strength is significantly correlated with the disability level of low back pain among wrestlers without radiologic abnormalities in the lumbar region.7
• Hip muscle weakness and patellofemoral pain are positively correlated in female athletes.8
• Trunk muscle weakness is a risk factor for low back pain. Individuals who developed low back pain displayed an imbalance between trunk extensor and flexor strength.9
• A bilateral imbalance in isometric strength of the hip extensors is related to the development of low back pain.10
• Athletes with stronger hip abductors and external rotation are less likely to experience low back pain.4
• Persistent muscle atrophy is related to recurrence of low back pain. A recurrence rate of 30% was found in subjects receiving core stabilization therapy, in comparison with 84% for those who received only conventional medical management.11
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Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.